Rural health clinic staff members have to navigate reams of regulations and bureaucratic red tape to collect for general care management services, but the good news is that collecting for these services is about to get a lot easier.
Check out four changes for 2024 that will help every rural health clinic collect more revenue in the new year.
1. Expect Pay for Community Health Integration
Effective January 1, 2024, CMS is allowing payment for a wide range of codes under the General Care Management Services category (G0511). One of those is Community Health Integration Services, which is typically reported with HCPCS code G0019, and another is Principal Illness Navigation Services, normally billed under HCPCS code G0023.
The intent is to reimburse rural health clinics (RHCs) for services furnished by community health workers under the general supervision of a physician. You’ll be able to bill for principal illness navigation services for time spent with patients who need help navigating the healthcare system and coordinating care for their health.
2. Plan to Collect for Remote Physiologic, Therapeutic Monitoring Services
CMS has been reimbursing physiologic monitoring and remote therapeutic monitoring for several years, but starting in 2024, the agency will pay these under General Care Management Services. This means a rural health clinic will now be able to be reimbursed for providing these remote monitoring services:
- Remote Physiological Monitoring (normally reported with 99454, 99457)
- Remote Therapeutic Monitoring (typically reported using 98976-77, 98980)
3. Prep for Reporting G0511 Multiple Times Per Month
Now that you have the opportunity to report general care management (G0511) for a wider range of services, you’ll be glad to know that you’ll soon have the option of reporting this code multiple times in calendar month, provided all requirements are met and resource costs are not counted more than once.
For instance, after Jan. 1, 2024, if you’re providing chronic care management services and you’re also providing remote monitoring services, rather than lumping that all together and billing one unit of G0511, you’ll be able to bill two units of G0511. This change represents a significant new revenue opportunity for RHCs as most rural health clinics begin to expand care management services to support their populations.
CMS has also changed the manner in which it calculates the payment for G0511. Going forward in 2024, CMS will calculate the reimbursement by using weighted averages of the non-facility utilization for specific services under the fee schedule. Payment for G0511 may drop by a few dollars in 2024, but RHCs will have the opportunity to collect for multiple units of the code.
4. Look for $23.72 for G0071
Your rural health clinic will also be able to collect $23.72 for G0071 when you perform communication technology-based services. These are non-face-to-face services furnished by an RHC practitioner, and typically involve remote evaluation of recorded video images.
For instance, suppose a patient has a rash and sends a photo of it to the doctor. The time the doctor spends reviewing that and communicating with the patient can be reported with G0071. It requires at least five minutes of work by the provider, and the patient must have been seen by the RHC within the last year. In addition, it must be in lieu of an in-person visit, meaning it can’t originate from a related E/M service provided within the prior seven days or lead to an E/M or procedure within the next 24 hours or soonest available appointment.
There’s much more you need to know to prepare your rural health clinic for 2024. Healthcare attorney Martie Ross, JD can walk you through all the steps during her exclusive online training event, Untangle Complex Rural Health Clinic Billing Rules to Get Paid More. Register today!
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